(Ilford North) (Lab)
(Urgent Question): To ask the Secretary of State for Health and
Social Care if he will make a statement on the impact of the
junior doctors’ strikes and what steps he is taking to prevent
further strike action in the NHS.
The Secretary of State for Health and Social Care ()
I am grateful to the hon. Gentleman for his question. On its
first part, we will not have firm figures on the number of
patient appointments postponed until later today, because the NHS
guidance has been to allow trusts a full working day to collate
the data on those impacts. We do know from the previous three-day
strike that 175,000 hospital appointments were disrupted and
28,000 staff were off. There is an initial estimate that 285,000
appointments and procedures would be rescheduled, but it is
premature to set out the full impact of the junior doctors’
strike before we have that data. I am happy to commit to
providing an update for the House in a written statement
tomorrow. In the coming days, I will also update the House on the
very significant progress that has been made on the successful
action taken over recent months to clear significant numbers of
78-week waits, which resulted from the covid pandemic.
It is regrettable that the British Medical Association junior
doctors committee chose the period immediately after Easter in
order to cause maximum disruption, extending its strike to 96
hours and asking its members not to inform hospitals as to
whether they intended to strike, thus making contingency planning
much more difficult. Let me put on record my huge thanks to all
those NHS staff, including nurses and consultants, who stepped up
to provide cover for patients last week.
I recognise that there are significant pressures on junior
doctors, both from the period of the pandemic and from dealing
with the backlogs that that has caused. I do want to see a deal
that increases junior doctors’ pay and fixes many of the non-pay
frustrations that they articulate. But the junior doctors
committee co-chairs have still not indicated that they will move
substantially from their 35% pay demand, which is not affordable
and indeed is not supported by those on the Opposition Front
Bench.
Let me turn to the second part of the hon. Gentleman’s question
and the steps we are taking to prevent further strike action in
the NHS. We have negotiated a deal with the NHS Staff Council; it
is an offer we arrived at together, through constructive and
meaningful negotiations. It is one on which people are still
voting, with a decision of the NHS Staff Council due on 2 May.
The largest union, Unison, has voted in favour of it, by a margin
of 74% in favour. So we have agreed a process with the trade
unions, which I am keen to respect, and we should now allow the
other trade unions to complete their ballot, ahead of that NHS
Staff Council meeting on 2 May.
Thank you, Mr Speaker, for granting this urgent question.
Finally, the invisible man appears; the Secretary of State was
largely absent last week during the most disruptive strikes in
NHS history. He was almost as invisible as the Prime Minister,
who previously said he does not want to “get in the middle” of
these disputes—what an abdication of leadership during a national
crisis. An estimated 350,000 patients had appointments and
operations cancelled last week—that is in addition to the
hundreds of thousands already affected by previous rounds of
action. Having failed to prevent nurses and ambulance workers
from striking, the Government are repeating the same mistakes all
over again by refusing talks with junior doctors. Patients cannot
afford to lose more days to strikes. The NHS cannot afford more
days lost to strike. Staff cannot afford more days lost to
strikes. Is it not time for the Secretary of State to swallow his
pride, admit that he has failed and bring in ACAS to mediate an
end to the junior doctors’ strike?
Last week also saw the Royal College of Nursing announce new
strike dates with no derogations and a new ballot. What does the
Secretary of State plan to do to avert the evident risks to
patient safety? Government sources briefed yesterday that they
are prepared to “tough it out”. That is easy for them to say.
Will the Secretary of State look cancer patients in the eye,
while they wait for life-saving treatment, and tell them to tough
it out, as they are the ones who will pay the price for his
failed approach?
Finally, writing in The Sun on Sunday, the Secretary of State
said that he is worried about patient safety, but he offered no
plan to get this matter resolved. He is not a commentator; he is
nominally the Secretary of State for Health and Social Care with
the power and responsibility to put an end to these strikes. When
will he put his toys back in the pram, stop blaming NHS staff,
sit down with junior doctors and negotiate a fair resolution to
this terrible, damaging and unprecedented dispute?
The shadow Secretary of State seems to ignore the fact that we
have negotiated a deal with the NHS Staff Council, and it is a
deal that it has recommended to its members. Indeed, the largest
health union has voted in favour of the deal—indeed it is his own
health union that has voted in favour of it—and yet he seems to
suggest that we should tear it up even though other trade unions
are voting on the offer, and their leadership had recommended
it.
Secondly, the shadow Secretary of State says that we should sit
down and negotiate. We have made an offer of 10.75% for last
year, compared with the Labour Government in Wales, who have
offered just 7.75%, which means that, in cash terms, the offer in
England is higher than that put on the table by the Welsh
Government, whom, I presume, he supports. He says that he does
not support the junior doctors in their ask of 35%, and neither
does the leadership there. We need to see meaningful movement
from the junior doctors, but I recognise that they have been
under significant pay and workforce pressures, which is why we
want to sit down with them.
The bottom line is that the deal on the table is reasonable and
fair. It means that just over £5,000 across last year and this
year will be paid for a nurse at the top of band 5. The RCN
recommended the deal to its members, but the deal was rejected by
just under a third of its overall membership. It is hugely
disappointing that the RCN has chosen not to wait for the other
trade unions to complete their ballot and not to wait for the NHS
Staff Council, of which it is a member, to meet to give its view
on the deal. It has chosen to pre-empt all that not only with the
strikes that come before that decision of the NHS Staff Council,
but by removing the derogations—the exemptions—that apply to key
care, including emergency care, which is a risk to patient
safety.
Trade unions are continuing to vote on the deal. The deal on the
table is both fair and reasonable, including just over £5,000
across last year and this year for nurses at the top of band 5.
The deal has been accepted by the largest union in the NHS,
including, as I have said, the shadow Health Secretary’s own
trade union. It pays more in cash to Agenda for Change members
than the deal on the table from the Labour Government in Wales.
It is a deal that the majority of the NHS Staff Council,
including the RCN’s own leadership, recommended to its members.
We have always worked in good faith to end the disruption that
these strikes have caused and we will continue to do so. None the
less, it is right to respect the agreement that we have reached
with the NHS Staff Council and to await its decision, which is
due in the coming weeks.
Mr Speaker
I call the Chair of the Select Committee.
(Winchester) (Con)
Reports over the weekend suggest that the British Medical
Association has asked its members not to engage with trusts if
they intend to strike, as the Secretary of State has confirmed
today. That is putting trust chief executives—and this is not
their fault—in an impossible position. They are being asked to
meet very challenging targets that we are rightly setting them,
not least with respect to the covid backlog. What more can he do
by his good offices to break that impasse? It is patients who are
losing out.
I agree; it is extremely surprising that the BMA has asked its
members not to liaise with NHS managers as they put in place
those contingency plans. I urge the BMA junior doctors committee
to think of those colleagues who have to provide the cover for
those strikes. I reaffirm my thanks to all those staff in the NHS
who provided cover following the Easter period, but it puts more
pressure on other NHS staff if the BMA junior doctors committee
is not willing for its members to liaise with management on
sensible contingency measures, as I urge them to do.
(York Central)
(Lab/Co-op)
The bigger dereliction of duty by the Secretary of State is not
addressing the retention crisis among junior doctors, who have
the choice of going to New Zealand or Australia, to be paid more
than double what they receive now, or to move over to work as
locums, where they will not carry the stress levels they
currently do. What is he doing to address the retention crisis of
junior doctors in the NHS?
In part, that is why my door is open and I am keen to discuss
with junior doctors the pressure they face not just on pay, but
on non-pay issues. There is the issue of support for the number
of doctors and the workforce plan we have committed to bring
forward to boost recruitment, but other non-pay issues are also
frequently raised by junior doctors, such as booking annual leave
and rostering. I am keen to work constructively with junior
doctors to address those, but for us to do so they need to move
from an unrealistic and unaffordable 35%, which the Leader of the
Opposition himself has recognised is an unreasonable
position.
(Morecambe and Lunesdale)
(Con)
The Secretary of State is right to say that the pay offer that
has been put on the table, notwithstanding the junior doctors, is
fair and reasonable. What should drive all parties in this
situation is putting patients first, moving forward to address
the serious challenges of recovering from covid and seeking to
address the issues within the NHS. Everyone should be focused on
patients first as this situation moves to a resolution.
I very much agree with my hon. Friend that this is a fair and
reasonable settlement. As I say, it is more than £5,000 at band
5, and the NHS Staff Council has recommended it. The majority of
trade unions, including the RCN, recommended this deal to their
membership. That is why we should respect the NHS Staff Council
process, respect the ballot that is still live and allow those
votes to continue.
(Hemsworth) (Lab)
Has the Secretary of State seen the recent report on the BBC that
billions of pounds—my words, not the BBC’s—are being squandered
on agency labour from private providers, with huge profits being
generated? Is it right that one doctor alone received £5,200 for
a single shift, as was reported by the BBC? What does the
Secretary of State think the impact of that would be on his own
staff? How can it be right for him to use bellicose language
about the staff associations and unions while larding money into
the pockets of the private agency providers?
One of the concerns at the moment is the BMA rate card, which is
significantly increasing the cost of providing the required cover
for the strikes, and in turn taking money away from things NHS
staff have raised with me, such as improving our tech offer,
improving the NHS estate and the many other priorities on which
money could be spent. I am keen, as I am sure the hon. Gentleman
is, to bring down the cost of agency workers. That is why we have
the commitment to the NHS workforce plan and why I am keen to sit
down constructively with the junior doctors committee, in the
same way that I did with the NHS Staff Council. After we reached
our deal, the leader of those negotiations for the trade unions
commented on the meaningful and constructive approach that we
took with the Agenda for Change negotiations. We are keen to do
the same with the junior doctors, but that has to be based on a
reasonable opening position from them.
(Peterborough) (Con)
When union bosses open their pay demands at 19% for nurses and
35% for junior doctors, is it any wonder that some ordinary
members feel let down when they have been asked to settle for a
generous and fair 5%? Would it not be far better if the BMA
junior doctors committee revised its ludicrous demand for 35%,
got around the table and did its members some service by
negotiating for a fair and reasonable pay offer?
I agree with my hon. Friend. The fact that even the Labour party
does not support 35%—the Leader of the Opposition himself says
that is not affordable —indicates how out of step the junior
doctors committee co-chairs are on what is realistic to get the
balance right in bringing down inflation and on the wider
economic pressures we face. We stand ready to engage
constructively with the junior doctors committee but, as my hon.
Friend says, that has to be on the basis of a meaningful opening
position.
(St Albans) (LD)
On 5 July, the British public will want to celebrate 75 years of
our amazing NHS, but if they are still feeling the brunt of NHS
strikes at that time, does the Secretary of State think it would
still be right for him to be at the Dispatch Box?
We have agreed an offer with the Agenda for Change staff council.
That is something that the staff council and the majority of
trade unions have recommended to their own members, and that the
largest health union has voted in favour of. I think we should
allow that ballot to take place; it reflects meaningful and
constructive engagement. That was reflected in the fact that
trade union leaders themselves recommended the deal to their
members. I hope that, when we come to the 75th anniversary, we
can celebrate that.
(Wokingham) (Con)
What actions are senior NHS managers taking to resolve non-pay
issues for which they could offer better work experiences to
doctors? What use can they make of flexibilities over pay
increments, promotions and gradings so that good staff can be
better rewarded?
As ever, my right hon. Friend raises an extremely important
point. As part of the negotiation with the AfC staff council, a
number of non-pay issues were discussed. Job evaluation is one
such issue. Likewise, for junior doctors, areas such as
e-rostering are extremely important. I share his desire for
investment in technology, and to look at the time spent by
clinicians that could be spent by others in the skills mix or
through better use of artificial intelligence technology and a
better estates programme. That is why it is important that we
continue to have that funding, as well as reaching the offer that
we have with the AfC staff council.
(Coventry South) (Lab)
Nurses, junior doctors and paramedics do not take strike action
lightly; it is a last resort after more than a decade of working
harder and longer for less and less. The Secretary of State will
say that there is no money for a fair pay deal, but that is not
true: it can be paid for by taxing the richest and redistributing
the wealth. Ending non-dom status would raise £3 billion;
introducing a 1% tax on assets worth over £10 million would raise
£10 billion; and equalising the capital gains and income tax
rates would raise £14 billion. What do the Secretary of State and
Conservative Members prefer: nurses having to use food banks, or
taxing the richest and making them pay their fair share?
The odd thing is that the hon. Lady seems to be disagreeing with
the trade union leadership, which is not her usual position.
Unison described it as a “decisive outcome” when 74% of its
members voted in favour of the deal. It is odd that she wants to
deny the GMB and other trade unions the space to vote on what
their leaders have recommended—the GMB leadership has also
recommended the deal to its members. Even the RCN leadership
recommended the deal to its members. As Pat Cullen herself
said:
“Negotiations work by compromise and agreement. We did not get
everything and nor did the government. Ministers made
improvements every day of those three weeks because we were able
to say that returning to striking was the clear alternative. No
union could enter negotiations and flatly say ‘no’ until you get
everything you want. These talks will not be reopened if members
reject this pay offer.”
The leadership of the RCN recommended the deal, as did the
leaderships of the GMB and Unison. It is odd that the hon. Lady
does not want to recognise that.
(Epsom and Ewell) (Con)
It is ironic to hear the British Medical Association complain
about staff shortages when it has in the past resisted the
expansion of training places for doctors. When there have been
disputes in the health service, those involved have always taken
steps to ensure that lives were not endangered by the dispute.
That appears to be no longer the case. That is, to my mind, a
dereliction of professional duty. Will my right hon. Friend send
the strong message to those involved that preserving life is a
professional duty that must be maintained?
My right hon. Friend is absolutely right to focus on patient
safety and the duty that all involved have to safeguard it.
Indeed, I have previously given the Royal College of Nursing’s
leadership credit and praise for granting strike exemptions,
known as derogations—notwithstanding our disputes, I was happy to
recognise that on the record. Given that less than a third of the
RCN’s total membership has voted against the deal, and that the
RCN’s leadership recommended it, it is very odd that it has now
hardened its position and removed those exemptions. I very much
hope that it will reflect further on the matter in the coming
days, because I think its previous stance of granting exemptions
was right.
(Leeds East) (Lab)
We need to be clear: junior doctors have had a 26% real-terms pay
cut. Restoring their pay would cost around £1 billion a year.
That is less than half the giveaway handed to the super-rich
through the non-dom tax avoidance scheme. Is it not the case that
a proper pay rise for junior doctors is affordable—it is just
that the Government have the wrong priorities?
It perhaps will not surprise the House to hear that the hon.
Gentleman disagrees with his party’s leader on that, because the
Leader of the Opposition says:
“I don’t think 35% is affordable”.
The hon. Member for Leeds East () is also wrong on the
quantum, because the cost would be £2 billion, not £1 billion as
he says. [Interruption.] Well, that has never been how
departmental budgets operate—not when his party was in power, and
certainly not now. He is wrong on the amount and wrong on the
policy.
Sir (New Forest East) (Con)
Given that the terms “emergency care” and “intensive care” imply
that the life of those who need them is at risk, does my right
hon. Friend share my dismay that people in that predicament are
now clearly being targeted by strikers? Will he—and hopefully his
Opposition counterpart—represent to the medical unions that
whatever other strike action they take, they should not endanger
the life of people in emergency or intensive care?
My right hon. Friend makes an extremely important point. Patient
safety should come first for all parties in this dispute. That is
why I urge the Royal College of Nursing to wait for the NHS Staff
Council decision on the offer. Voting is still ongoing, and it
would be premature to announce strike action ahead of that
decision.
(Wirral West) (Lab)
Nurses and junior doctors are being pushed to breaking point,
because there simply are not enough of them, and the Government
have failed to plan the workforce properly. A nurse I spoke to at
the weekend told of the terrible queues in corridors, and said
that patients were waiting in pain, and not in the dignified
environment that they should be in. She also spoke of the lack of
care packages to enable the safe discharge of many patients. Why
are we still waiting for the NHS workforce plan, which the
Government promised? Can the Secretary of State tell us on what
date we can expect to hear a statement on it? Also, what urgent
action will he take to address the social care crisis?
On social care, which relates to the hon. Lady’s point about
discharge, she will recall that in the autumn statement the
Chancellor put additional funding into adult social care—funding
of up to £7.5 billion over two years, which is the largest ever
increase in funding for social care. Also, I announced at the
Dispatch Box in early January a reprioritisation of funding in
the Department—it was a £250-million package—in the light of
urgent and emergency care pressure. That included funding to
support greater discharge, to get more flow. I touched on the
workforce plan earlier. We will publish it shortly; in the autumn
statement, the Chancellor committed to doing so.
(Southend West) (Con)
Does my right hon. Friend agree that the BMA pay demands are over
four times the average private sector pay increase and that, were
the Government to agree to them, they would place a huge
additional tax burden on hard-working taxpayers across the
country—including in Southend West—at just the time when they are
battling with an unprecedented cost of living crisis?
I do agree with my hon. Friend. If that demand were agreed to, it
would mean some junior doctors receiving a pay rise of over
£20,000. We need to find a balance, with a fair and reasonable
settlement for NHS staff, recognising the huge pressure from the
pandemic and the backlogs it has caused, while at the same time
bringing inflation down, because that matters not just to NHS
staff, but to all working people who are impacted by
inflation.
(City of Durham) (Lab)
The BMA has made it crystal clear that it is willing to enter
into negotiations, so will the Secretary of State commit right
now to asking ACAS to negotiate and mediate? If not, why not?
As I have said, we need to see meaningful movement from the BMA.
The 35% demand that it has set out is not affordable, which is a
point that is recognised by most colleagues across the
House—certainly, Opposition Front Benchers recognise it. We need
to see significant movement from the BMA to be able to have
constructive and meaningful engagement.
(Boston and Skegness)
(Con)
I welcome the Secretary of State’s acknowledgement that junior
doctors deserve a pay rise, and not just because my wife is a
junior doctor, and his focus on non-pay issues. For all the talk
about ACAS from Opposition Members, is it not the case that so
long as the BMA leadership maintain that their starting point is
35%, there is no point in going to ACAS, because the BMA is not
prepared to negotiate? It is setting its face against the
interests of doctors and patients. The only way to get through
this is to get around the table with a meaningful starting point,
and that cannot be 35%, as the Leader of the Opposition has
said.
I very much agree with my hon. Friend, and he is right to
highlight the wider issues that we want to discuss. The previous
negotiation with the junior doctors included, for example,
setting up a higher pay band, which has meant that there has been
a cumulative increase of over 24% over four years. It included
targeted action such as a £1,000 a year allowance for junior
doctors who work less than full time, and targeted action around
unsocial hours and weekend work. Those are the meaningful
discussions that we want to enter into with junior doctors, but
that has to be on the basis of a realistic and deliverable
discussion, and 35% is not that.
(Kingston upon Hull North)
(Lab)
I am not sure the Secretary of State understands just how angry
people are. My constituents are absolutely furious with the
Government’s stewardship of the NHS. Hull is the most
under-doctored area in the country; we have the longest waits in
A&E in the country; and we have had a very poor Care Quality
Commission report on our local hospitals. On the junior doctor
strikes, when will the Secretary of State start to put patients
first? I want to make sure that he goes away from this Chamber
and gets ACAS involved, so that we can get the junior doctors
back at work, with no further delays and cancellations for my
constituents and patients in Hull.
The rather odd thing is that we have a larger cash offer on the
table for 2022-23 than the Labour Government in Wales, and we
have reduced our longest waits far more than they have in Wales.
We have a deal that the trade union leaders themselves have
recommended, that the majority of staff councils have recommended
and that the largest health union has voted emphatically in
support of. It is right that we allow time for that deal to go
through, and we stand ready to have similar meaningful and
constructive engagement with the junior doctors once they move
from what is an unrealistic position.
(New Forest West) (Con)
Regulars in this Chamber will know that Opposition Members have
habitually taken to urging Ministers to adopt their own policies.
Does the Secretary of State share my difficulty that, in respect
of this urgent question, none of us has any idea what their
policy is?
In short, the position of the shadow Health Secretary seems to be
to deny the vote of his own union, Unison, which voted 74% in
favour; to not wait for the NHS staff council to reach its
decision; and to unravel to some extent what has been meaningful
and constructive engagement with the “Agenda for Change” staff
council. My right hon. Friend is right to be confused about the
Opposition’s actual position.
Sir (Rhondda) (Lab)
I can see at least two other Members in the Chamber who know from
personal experience that early diagnosis and treatment of cancer
can save lives. I very much hope that any action taken over the
next few weeks will not affect that, because that could mean
people losing their lives before their time.
I have two significant worries about the long-term future of the
NHS. One is seeing so many people, including those from poor
constituencies and poor families, using all their life savings to
buy an operation, because they know that that is their only means
of getting back to work as there is such a long backlog. That
feels like a form of privatising the NHS.
Secondly, there are terrible problems with recruitment and
retention, with more than 110,000 vacancies in the NHS. I really
hope we will see the workforce paper soon. It has been promised
for a very long time, and I suspect “summer” may go on until
autumn—it tends to every year, I suppose. It would be good to see
that paper soon, because there are so many different parts of the
NHS where we need to recruit more people. Everybody in this round
is worrying, “Will the NHS be worth working for in 10, 15 or 20
years’ time?”. We can only do this if there is real confidence in
the future.
The hon. Gentleman makes two important points. The workforce plan
is critical, and I have referred to that already. He also raises
the importance of early diagnosis of cancer, and he is absolutely
right on that. He will have seen that the faster diagnosis
standard was met in the latest operational performance data for
February, which was extremely welcome news. There is obviously
more still to do. That is why we are rolling out the programme of
diagnostic centres and surgical hubs. We are redesigning patient
pathways to streamline those journeys, and we are looking at
variation in performance on such things as faecal immunochemical
tests. There is a huge amount of work, but I hope he can see some
progress in the latest figures.
More widely in terms of elective recovery, we made progress in
the summer on the two-year waits, in stark contrast to Wales,
which was significantly above 50,000. We got it under 2,000 in
the summer. I will update the House shortly on the 78-week waits.
We are working through the key actions in our elective recovery
plan as we deal with the consequences of the build-up from the
pandemic.
(Newcastle-under-Lyme)
(Con)
We all recognise how hard junior doctors work, but if we are to
have successful negotiations, we need honesty and integrity in
them. Does the Secretary of State share my concern that the BMA’s
figure—its central campaign claim—of £14-an-hour pay for junior
doctors has been shown to be misleading?
I do share my hon. Friend’s concern. Full Fact has shown that the
figure is inaccurate. It disregards higher pay later in the
evenings and at weekends. It ignores the 20% that goes into
pensions and that junior doctors, probably more than any other
profession, have very quick pay and career progression. That is
why, as part of our listening exercise, we made changes to
pensions in the Budget. That was a reflection of the fact that
senior doctors have often accumulated those pension pots, which
is one of the other challenges we are dealing with. It is an
indication of the career and pay progression that many junior
doctors will see later in their careers.
(Strangford) (DUP)
I thank the Secretary of State very much for his endeavours to
find a pay settlement, ever mindful that it is more than pay that
some NHS staff wish to see. To give an example of that, I
recently sat listening to one of my constituents who is in
foundation year 1. She was brought to tears by the stress and
pressure on her young shoulders. When she finally finishes
shifts, she lies awake going over the decisions made. In her
view, she would keep her pay the same to have more qualified
staff available. How will the Secretary of State’s proposals make
adequate support on the wards possible?
The hon. Gentleman raises an important issue, and there is a lot
more we can do around the skills mix in the NHS and ensuring that
people operate at what is referred to as the top of their licence
and make the maximum of the training they have. Often there are
restrictions in place. We are looking at physician associates and
medical examiners and at the role of pharmacists within primary
care, as well as at how we get the right continuing professional
development to train people, so that we get more of the career
ladder from different roles.
There is a lot that we are looking at, in the context of the
workforce plan, around the right skills mix, the right training
and job evaluation. That was one of the issues in my discussions
with the staff council—for example, there was a particular focus
on apprenticeships. Sometimes people take a pay hit when they go
into an apprenticeship if they were at the top of their previous
band. That is one of the things we agreed to work on with the
staff council. Again, I am sure that an area of consensus in the
House will be that apprenticeships offer great opportunities for
people to progress, and we should not have a financial penalty
when people pursue them.
(Bury North) (Con)
Many hon. Members have raised extremely important points, but the
central issue is that the reckless and irresponsible actions of
two trade unions are putting the lives of my constituents and
people throughout the country at risk. The right to strike can
never trump people’s right to receive healthcare and not have
their life threatened by the actions of left-wing trade unions.
Can I ask what my right hon. Friend is going to do to address
this issue and to hold trade unions to account if they continue
with this appalling behaviour?
I share my hon. Friend’s concern. We have worked constructively
with the Royal College of Nursing and, as I say, I was happy to
put on the record my acknowledgment of the exemptions it had
previously granted. I hope that between now and the end of the
month, it will further reflect on the fact that the 48 hours of
continuous strike action will happen without consultation with
other staff council members and without waiting for the decision
of other trade unions that are currently balloting. He will know
that “Agenda for Change” is a deal that covers all the trade
unions, not just the RCN in isolation, and I think it is right to
wait for all the trade unions to vote and for the staff council
to meet.
(Sleaford and North
Hykeham) (Con)
I draw the attention of Members of the House to my entry in the
Register of Members’ Financial Interests.
On Friday, I was working at the hospital and my usual clinic had
cancelled all but one patient. I spoke to the secretaries about
the various cancellations they had had to make as result of the
strikes, and I was really sad to hear not only that they had
often been verbally abused by people who were upset, but that
they have had to cancel some patients on two occasions because of
the earlier strikes and the more recent ones. I was also sad to
hear that we are looking at further strikes in the next few
weeks.
Will the Secretary of State join me in thanking the members of
staff who came into work, who did not strike and who continue to
deliver a very important and valuable service? What is he doing
to expedite the legislation on minimum service guarantees, so
that we do not have any implications from strikes on emergency
and intensive care in particular?
First, I thank my hon. Friend for her service and for the work
she was doing on Friday. I join her in putting on the record my
thanks to all those staff who did provide cover, as I said in my
opening remarks. She is right to highlight the minimum service
legislation, and we will obviously need to reflect on recent
events in that context. She also points to the fact that the
decision by the BMA junior doctors committee to advise members
not to notify hospital management about whether they were
striking obviously made it more likely that clinics would be
cancelled, even when it then transpired that doctors could have
provided cover. That is clearly regrettable and indicates the
need for resolution, and we want to work constructively with the
junior doctors on this.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
“Mr Speaker, the honourable gentleman seems to ignore the fact
that we have actually negotiated a deal with the NHS Staff
Council, and it is a deal that it has recommended to its members.
Indeed, the largest health union has voted in favour of the
deal—indeed, it is his own health union—yet he seems to think we
should tear it up, even though other trade unions are still
voting in response to that offer and their leadership had
recommended it.
Secondly, he says that we should sit down and negotiate. We have
made an offer of 10.75% for last year, compared with the Labour
Government in Wales, who have offered just 7.75%. So the offer,
in cash terms, in England is actually higher than the offer that
is being put on the table by the Welsh Government, which I
presume he supports. He says he does not support the junior
doctors in their ask for 35%, and nor does the leadership there.
We need to see meaningful movement from the junior doctors, but I
recognise that doctors have been under significant pay and
workforce pressures, which is why we want to sit down with them.
The bottom line is that the deal on the table is reasonable and
fair. It means that just over £5,000 across last year and this
year will be paid for a nurse at the top of band 5. The RCN
recommended this deal to its members, but it was rejected by just
under a third of its overall membership. It is hugely
disappointing that the RCN has chosen not to wait for the other
trade unions to complete their ballots and not to wait for the
NHS Staff Council, of which it is a member, to meet to give its
view on the deal. It has chosen to pre-empt that, not only with
the strikes that come before that decision of the NHS Staff
Council but by removing the derogations—the exemptions—that apply
to key care, including emergency care, which is a risk to patient
safety.
Trade unions are continuing to vote on this deal. The deal on the
table is both fair and reasonable, including just over £5,000
across last year and this year for nurses at the top of band 5.
It has been accepted by the largest union in the NHS, including,
as I have said, the shadow Health Secretary’s own trade union. It
pays more in cash to AfC members than the deal on the table from
the Labour Government in Wales. It is a deal that the majority of
the NHS Staff Council, including the RCN’s own leadership,
recommended to its members. We have always worked in good faith
to end the disruption that these strikes have caused and we will
continue to do so, but it is right to respect the agreement that
we have reached with the NHS Staff Council and to await its
decision, which is due in the coming weeks.”
(Lab)
My Lords, last week was the most disruptive in the history of the
National Health Service, with some 350,000 patients seeing their
operations and appointments cancelled due to industrial action.
Does the Minister accept that the public remain supportive of
doctors and nurses and also that the public want to see the
Government reaching fair, negotiated settlements to bring
disruption to an end? If Ministers remain unable to get
agreements over the line, what other options are being pursued,
including the involvement of ACAS?
(Con)
I think we all want fair outcomes and negotiated settlements, and
I think we felt that the agreement reached with the Agenda for
Change parties was fair and was something, as mentioned in the
Statement, that the union leadership recommended to the union
members. Of course, we need to wait to see the outcome of the
staff council of all the Agenda for Change unions from 2 May to
see where we end up on that. Our hope is that, across the
majority of those, we will see support. As noted, this is a
generous offer; it is higher than the offer made in Wales, for
example, and we hope it will be a way forward after 2 May. If
that is not the case, we need to sit down and think about next
steps.
(LD)
My Lords, the Secretary of State in the other place rightly
referred to the workforce plan as essential to dealing with some
of the stress that is contributing to the industrial action. I
checked the record, and the Minister first told us that this plan
was going to be released “shortly” on 2 February. Yet Valentine’s
Day came and went, and there was no plan. Now, Easter has come
and gone, and there is no plan. I wonder if the Minister could
tell us whether “shortly” is getting shorter or longer? Should we
be expecting the plan closer to the Coronation or the 75th
anniversary of the NHS in July?
(Con)
I am afraid I cannot provide a lot more information to the noble
Lord, except that complications now include the purdah for local
government elections, so I am trying to find out more details on
this very subject as to when a date could be set. I am afraid to
say I cannot give much more of an update than to say it will be
released shortly. What I will say is that, among all this, we are
still seeing increases in staff. I was delighted to see that we
now have 5,100 more doctors in place than last year, and we have
had an increase over the last few years of 30,000 nurses. So,
there are movements in the right direction, but clearly more
needs to be done.
(CB)
My Lords, we still call it the National Health Service, but the
Minister will be aware of the alarming figures for people who
have no choice but to move to private provision of care. The
numbers registering even for GP services privately must give
cause for alarm, because we have got to be in this together to
retain the national character of the National Health Service. I
appreciate the Government’s concern about higher inflation due to
very large settlements, but perhaps the answer is to sit down
through ACAS, as the noble Baroness said, and think about
slightly more generous one-off payments, because that will not
bake in the inflation or increase costs in the longer term.
(Con)
I thank the noble Baroness. As I mentioned, we felt we had put a
fair offer on the table—something that was recommended by the
trade union leaders themselves. I think we need to see the
overall verdict come out across the board on all this. I note
that less than a third of the membership of the RCN actually
turned it down in the end, so we have to see what the overall
outcome is. There is an absolute commitment on our side to
continue meeting constructively with the RCN and to use all means
possible to get to a solution.
(Con)
My Lords, those who have awarded degrees to doctors and heard
them take the Hippocratic oath that they shall do no harm can
scarcely be impressed by action being taken in which the
public—patients—are suffering and in which enormous pressure is
put on other colleagues in the health service. I, for one, think
this is a very miserable occasion, and I hope to goodness that
all those in the health service involved in action will think
again.
I would like my noble friend to remind us about the importance of
the pay review bodies, which were fought for long and hard. If we
jeopardise or undermine them, that will be a long-term legacy
that not only this Government but a Government of any other
persuasion may pay the price for. Can he also say a little more
about junior doctors and the steps being taken to increase their
remuneration and deal with their working patterns?
All will agree that the health service today is extraordinarily
complex. When I was Secretary of State, we spent 5% of GDP on
health. That figure is now 12%, and there is not an infinite pit.
I hope that reason will prevail.
(Con)
I thank my noble friend for her questions and the wise points
borne out by her own experience. The impact this is having on
patients is a regret to us all. On derogations, the history has
been that the unions have sat down and made sure that life is
protected. It is a regret that the BMA junior doctors have not
done that in this instance, and that the RCN is saying right now
that it is not considering derogations in its new strike. I hope
that this position will change. I do not think anyone in this
Chamber would want to see life threatened in this way. I know
that we are doing everything we can on our end—as I say, offering
more than devolved Governments—to solve this situation. I ask for
good will on all sides so that we can protect patients first.
(GP)
My Lords, in following on from the last question, I point out
that the rising percentage of GDP spending reflects a fast-ageing
population and the fact that we have terrible levels of public
health, terrible housing and terrible diets. All sorts of other
issues that are putting huge pressures on our NHS are at
historically high levels.
I want to focus on the junior doctor situation in particular.
There are currently 9,000 NHS doctor vacancies. The rate of
departure of doctors from the NHS is twice what it was a decade
ago. Does the Minister acknowledge that the situation of doctors
in particular—and, in fact, that of all medical professionals—is
rather different from other professions in the sense that we have
a huge global shortage of medical professionals? We are seeing
many doctors voting with their feet over their current terms and
conditions and leaving the NHS, and the Government are not in
what you might call a normal industrial situation of saying,
“Well, we’ll just have to play tough and negotiate”. There is a
huge risk that we are going to lose a whole generation—or
generations—of doctors from the NHS who are irreplaceable. The
Government have to look at this in a co-operative way to find a
way forward, rather than setting out a confrontational approach
to the strike action.
(Con)
I thank the noble Baroness. Yes, we do live in a global market.
We absolutely have to be mindful of the fact that if our working
conditions are not attractive, people will vote with their feet.
At the same time, I am glad to say that we have 5,100 more
doctors than we did last year, as I mentioned earlier. Clearly we
want to do more work on that, but the proof of the pudding is in
the eating, so to speak. That is not to say that we do not want
to retain as many doctors and nurses in all their professions. Of
course, that is what the workforce plan will be all about as
well.
